Evaluation and Management of the Patient With Suspected Inflammatory Spine Disease

Axial spondyloarthritis (AxSpA) is a chronic inflammatory rheumatic disease characterized by inflammatory back pain (IBP) that manifests in childhood, late adolescence, or early adulthood. Ankylosing spondylitis (AS) and nonradiographic AxSpA represent 2 ends of the AxSpA spectrum. Diagnosis can be challenging because patients develop IBP that may not be associated with radiographic changes in the sacroiliac joints. Patients early in the course of disease are estimated to have at least the same level of disease activity and pain as patients with established disease; thus, they could benefit substantially from earlier diagnosis. Although the recent use of magnetic resonance imaging and its inclusion in diagnostic criteria has enhanced the identification of early AxSpA, improvement in early diagnosis has not been consistently reported across all studies. Limited knowledge of the continuum of AxSpA disease manifestations and lack of recognition of IBP in primary practice may contribute to this. Implementing a referral strategy that identifies patients with IBP for additional testing and assessment may lead to better recognition of early signs and symptoms of AxSpA, thereby offering the potential for improved patient outcomes. This review presents an overview of the epidemiology, clinical characteristics, and burdens of AxSpA, followed by a case presentation outlining approaches to the evaluation and management of a patient with suspected inflammatory spine disease.     

拟定Ⅰ期强直性脊柱炎的影像学诊断

目的 :拟定强直性脊柱炎 (AS)的早期 (Ⅰ期 )影像学诊断标准。方法 :14 63例骶髂关节CT检查中 ,正常 2 84例 ,AS 1179例 ,Ⅰ期 483例 ,并经过中西医结合治疗 ,以及治疗前后影像学对比观察。结果 :正常骶髂关节 :①关节面光整 ,骨皮质密度均匀 ,厚薄一致 ;②关节间隙宽度呈左右、上下对称一致 ;③紧靠关节面骨皮质的松质骨小梁清晰可辨。Ⅰ期AS的影像学表现为 :①髂骨侧关节面骨皮质模糊 ,浓密不均 ,部分骨皮质消失或完全消失 ;②髂骨侧紧靠骨皮质的松质骨小梁难以辨认 ;③关节间隙狭窄。Ⅰ期AS经过中西医结合治疗后可完全痊愈 ,未经治疗的Ⅰ期变为Ⅱ期 ,即关节面出现缺损。结论 :拟定的Ⅰ期AS影像学诊断经治疗前后的影像对比证明是正确的     

拟定Ⅰ期强直性脊柱炎的影像学诊断

目的：拟定强直性脊柱炎(AS)的早期(I期)影像学诊断标准。方法：1463例骶髂关节CT检查中，正常284例，AS1179例，l期483例。并经过中西医结合治疗，以及治疗前后影像学对比观察。结果：正常骶髂关节：①关节面光整，骨皮质密度均匀．厚薄一致；②关节间隙宽度呈左右、上下对称一致；③紧靠关节面骨皮质的松质骨小梁清晰可辨。I期AS的影像学表现为：①髂骨侧关节面骨皮质模糊，浓密不均，部分骨皮质消失或完全消失；②髂骨侧紧靠骨皮质的松质骨小梁难以辨认；③关节间隙狭窄。I期AS经过中西医结合治疗后可完全痊愈，未经治疗的I期变为Ⅱ期，即关节面出现缺损。结论：拟定的I期AS影像学诊断经治疗前后的影像对比证明是正确的。     

Fluoroscopically Guided vs Landmark-Guided Sacroiliac Joint Injections: A Randomized Controlled Study

Objectives

To determine the prevalence of intra- and extra-articular sacroiliac joint (SIJ) pain, which injection is more beneficial, and whether fluoroscopy improves outcomes.

Mechanics of pelvic girdle stability and self-bracing in SIJ-related pelvic girdle pain: a review

Abstract

Background:

Pelvic girdle mechanics and control is a rapidly evolving area of research. Our traditional understandings were firmly grounded in theory borrowed from the fields of engineering (mechanical and structural) but have since began to branch out into neuroscience and motor control. The melding of mechanical concepts with those of neuroscience have led to a much better understanding of the effect of pain on the function of the pelvic girdle, specifically functional load transfer. Yet our understanding of the aetiology of pain particularly, chronic pain and recurrent pain pathways, is elusive.

Objectives:

The aim of the current review was to assess the mechanical and motor control components to pelvic girdle stability and propose a hypothetical model for mechanical aetiology of chronic posterior pelvic girdle pain.

Results:

A potentially new paradigm is offered on the current models of insufficient versus excessive force closure. The proposed model takes into account dynamic movement scenarios where the effect of anticipatory postural adjustment (APA) would be responsible for engaging local muscles to effectively elicit self-bracing of the sacroiliac joints (SIJ) for load transfer. When this mechanism fails the system would rely on compensatory postural adjustment (CPA) reliant on aberrant global muscle activation to stiffen the lumbar–pelvic–hip complex.

Conclusions:

For load transfer to be successful the pelvic girdle must be stabilized. The author has shown how disturbance of a component of this dynamic link may destabilize and disrupt the load transfer mechanism, resulting in low back pain of SIJ origin.